1. Field of the Invention
The present invention relates to a medical apparatus and its method of use and more particularly to a gastroenteric feeding tube which is adapted for endoscopic placement into the duodenum area of a patient's intestines.
2. Prior Art
The necessity to provide nutrition for comatose or otherwise debilitated patients has been addressed in various ways by the medical industry. The technique utilized in some cases has been intravenous feeding wherein the nutrients are directly conveyed into the bloodstream of the patient. Another way in which the problem of restoration and maintenance of fluid and nutritional balance is resolved is by means of intubation, where a tube is passed through the nasal passage and into the stomach or intestines of a patient, the tube having one or more apertures to permit the introduction of strained or comminuted foods which can be introduced in fluidized form.
Gastroenteric or nasoenteric feeding tubes have generally been found to be useful for administering the feeding formulas to such patients who are unable to meet their normal nutritional retirements through oral intake of food, but who nevertheless have functional gastrointestinal tracts. Generally, a gastroenteric feeding tube comprises an elongated tubular flexible main portion having distal and proximal ends and includes at least one side aperture therein adjacent the distal end, and a weighted bolus on the distal end. The proximal end of the feeding tube would typically have a single tube connector or a "Y" shaped type connector affixed thereto. A feeding tube of this type is generally installed in a patient so that it extends through one of the patient's nostrils, through the esophagus, into the stomach and preferably past the pylorus into the duodenum area of the intestines. Once a gastroenteric feeding tube has been properly installed in a patient, feeding formula can be effectively administered to the patient by passing it through the tubular main portion so that the formula passes into the patient's intestines through the aperture adjacent the distal end of the main portion.
It is generally preferable to install a feeding tube in a patient so that the distal end portion thereof is positioned past the patient's pyloric valve in either the duodenum or the jejunum area of the patient's intestines. It has been found to be more beneficial if the feeding formula can be passed directly into a patient's intestines rather than into the patient's stomach.
One technique which has heretofore been found to be effective for installing a feeding tube in a patient is to utilize a wire stylet which is inserted into the main lumen of the feeding tube to add stiffness thereto so that it can be manipulated during installation procedures. However, while this method has been effective for installing a feeding tube so that the bolus portion thereof is positioned in the stomach of a patient, it has not been found to be effective for moving the bolus portion of the feeding tube past the pyloric valve of the patient and into the duodenum or jejunum area of the patient's intestines.
Recently, it has been found that endoscopic procedures can be utilized to assist in installing gastroenteric feeding tubes in patients so that the bolus portions thereof are positioned beyond the pyloric valves of patients. In this regard, a number of relatively sophisticated fiber optic endoscopic devices have been developed which can be effectively utilized for assisting in mechanically moving the distal end portions of feeding tubes past the pyloric valves of patients. More specifically, endoscopic devices have been developed which are operable with appliances having grasping or snaring forceps on the distal ends thereof which can be utilized for grasping the ends of feeding tubes to install them in patients. Unfortunately, however, it has been found that most of these endoscopic devices are extremely delicate, and that they cannot be utilized for effectively manipulating feeding tubes having any degree of stiffness. It is also very difficult to pass both the grasping device and feeding tube through the pyloric valve at the same time.
Heretofore, it has been impossible to use a regular enteral feeding tube through the working channel of an endoscope because of the difficulty of removing the endoscope from about the enteral feeding tube once the tube is properly placed past the pyloric valve and into the duodenum of the patient. An endoscope is an instrument for the examination of the interior of a canal or hollow viscus and typically comprises an elongated flexible body having a fiber optic cable to allow its user to view the area surrounding its distal end. Often times, the endoscope additionally has an elongated internal lumen or working channel provided therethrough to allow the user to insert various working instruments through the endoscope to perform various functions within the canal or hollow viscus of a patient. Furthermore, some endoscopes have a steerable distal end to assist in positioning the tip while advancing the endoscope within a patient. However, with enteral feeding tubes of the prior art it is difficult to remove the endoscope from about the feeding tube because the feeding tube would typically have an end connector affixed to its proximal end for hookup to a feeding pump and such a connector would not fit through the working channel of the endoscope. Furthermore, with the use of known feeding tubes it would be impossible to hold the feeding tube in place while removing the endoscope from about the feeding tube without disturbing the feeding tube's placement within the patient.
Accordingly, it is an object of this invention to provide an enteral feeding tube which can be utilized through the working channel of an endoscope and without the use of a separate grasping endoscopic tool.
Another object of this invention is to provide an enteral feeding tube which can be utilized through the working channel of an endoscope such that once the tube is properly positioned within the patient, the endoscope can be removed from about the feeding tube without disturbing the placement of the feeding tube within the patient.
It is another object of this invention to provide an enteral feeding which can be utilized through the working channel of an endoscope which has been inserted into a patient's mouth such that once the tube is properly positioned within the patient, the endoscope can be removed from about the feeding tube and the proximal end of the feeding tube can be repositioned through the patient's nasal passageway without disturbing the distal placement of the feeding tube within the patient.
It is another object of this invention to provide a novel method of placing an enteral feeding tube through the stomach, past the pyloric valve and into the duodenum of a patient through the use of an endoscope having a working channel and a steerable tip.
It is yet another object of this invention to provide a method of properly placing an enteral feeding tube into the duodenum of a patient through the use of an endoscope having a working channel and steerable tip including the steps of positioning the feeding tube within the patient, removing the endoscope from about the feeding tube without disturbing the placement of the feeding tube within the patient, repositioning the proximal end of the feeding tube through the patient's nasal passageway, and connecting an appropriate connector on the proximal end of the feeding tube for connection to a feeding pump and/or solution.